Department of Radiology, Inha University Hospital, Inha University College of Medicine, Jung-gu, Incheon, Korea.
Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea.
Diagn Interv Radiol. 2021 May;27(3):372-377. doi: 10.5152/dir.2021.20183.
We aimed to investigate the incidence, etiology, treatment, and clinical course of atypical iliac vein compressions (AIVCs) among patients with May-Thurner syndrome (MTS).
A total of 173 patients who presented with MTS were retrospectively analyzed at a single center. Computed tomographic venography (CTV) was used to diagnose MTS. An AIVC was defined as the compression of the left common iliac vein (LCIV) by structures other than the right common iliac artery (RCIA) or the compression of other venous structures in the pelvic cavity instead of the LCIV. The patients with AIVC were categorized into the LCIV compression group (category A) and non-LCIV compression group (category B).
Ten patients with AIVC were identified (5.8%; male/female, 5/5), five in category A and five in category B. The median age of patients was 76 years (range, 51-94 years), and the median follow-up duration was 388 days (range, 12-4694 days). In category A, the LCIVs were compressed by the left common iliac artery (LCIA) (n=2), uterine leiomyoma (n=1), LCIA aneurysm (n=1), and RCIA aneurysm (n=1). In category B, the right common iliac veins were compressed by the RCIA (n=4) and L5 osteophyte (n=1). Endovascular treatment, including balloon angioplasty and stent placement, was performed in six patients, three from each group. Three patients underwent conservative treatment due to their advanced age and comorbidities. Endovascular aneurysm repair was performed in one patient with RCIA aneurysm. Follow-up images were available for six patients, and all of them had patent venous flow.
The AIVC had an incidence of 5.8% (10/173) among symptomatic MTS patients and wide spectrum of etiologies. Pathogenesis-tailored endovascular treatments are safe and effective.
我们旨在研究肌间静脉压迫综合征（MTS）患者中不典型髂静脉压迫（AIVC）的发生率、病因、治疗方法和临床病程。
在一家单中心医院对 173 例 MTS 患者进行回顾性分析。采用计算机断层静脉造影（CTV）诊断 MTS。AIVC 定义为左髂总静脉（LCIV）受压，受压结构除右髂总动脉（RCIA）以外，或受压部位为盆腔内其他静脉结构而非 LCIV。将 AIVC 患者分为 LCIV 受压组（A 组）和非 LCIV 受压组（B 组）。
共发现 10 例 AIVC 患者（5.8%；男/女，5/5），其中 A 组 5 例，B 组 5 例。患者的中位年龄为 76 岁（范围 51-94 岁），中位随访时间为 388 天（范围 12-4694 天）。A 组中，LCIV 分别被左髂总动脉（LCIA）（n=2）、子宫肌瘤（n=1）、LCIA 动脉瘤（n=1）和 RCIA 动脉瘤（n=1）压迫。B 组中，右髂总静脉分别被 RCIA（n=4）和 L5 骨赘（n=1）压迫。6 例患者接受了血管内治疗，包括球囊血管成形术和支架置入术，每组各 3 例。3 例患者因高龄和合并症而接受保守治疗。1 例 RCIA 动脉瘤患者接受了血管内动脉瘤修复术。6 例患者可获得随访图像，所有患者静脉血流均通畅。
在有症状的 MTS 患者中，AIVC 的发生率为 5.8%（10/173），病因广泛。针对发病机制的血管内治疗安全有效。
